Capillary Hemangioma (Stawberry Nevus)

Definition

A capillary hemangioma is a bright red birthmark. These are one of the most common benign orbital tumors of infancy. They are benign endothelial cell neoplasms that are typically absent at birth and characteristically have rapid growth in infancy with spontaneous involution later in life. Some are cute; some are large and unsightly. Fortunately, most will disappear on their own within about two years. Whether hemangiomas are treated or not, babies deserve to have parents and others look at them with wonder and delight. Hemangiomas may be present anywhere on the body. However, they are most disturbing to parents when they are on the infant's face or head. Hemangiomas of the eyelid may interfere with the development of normal vision and must be treated in the first few months of life. On rare occasions, the size and location of hemangiomas may interfere with breathing, feeding, or other vital functions. These lesions also require early treatment.

Causes

1. The cause is unknown. They are usually not present on birth time but later developed after birth.
2. The color results from the extensive development of blood vessels at the site. The more blood in vessels, redder is the skin. Normal skin goes pale when we are cold i.e. blood vessels constrict and goes bright red when we blush i.e. blood vessels dilate.
3. These are similar to strawberry hemangioma but situated deep in the skin.

Symptoms

1. In capillary hemangioma there develop skin markings before or shortly after birth.
2. Skin rash or lesion that is red
3. There may be skin markings that look like blood vessels.
4. Patients can have severe symptoms like seizures, headaches, paralysis, bleeding in the brain and even death. The nature and severity of the symptoms depend on the lesion's location in the brain.

Treatment

1. Watchful waiting is usually recommended
2. In children it is usually self limiting. So a watchful waiting is needed. Hence no special treatment is needed. The capillary hemangioma tends to resolve as the child grow up.
3. Topical steroid formulations, such as clobetasol propionate cream, can be applied topically to the lesion. The response to these treatments, even with the strongest corticosteroid formulations, is slower than other methods because several weeks are required to obtain a response.
4. Systemic corticosteroids are used for amblyogenic life-threatening lesions. Complications of systemic therapy with corticosteroids include Cushingoid changes, personality changes, gastrointestinal irritation, oral candidiasis, delayed growth, diabetes, hypertension, and rebound growth of hemangiomas on cessation.
5. Laser surgery has been attempted to ameliorate capillary hemangiomas but still is controversial. The hemostatic effects of the carbon dioxide laser have been used with success to surgically remove these lesions.
6. Consultations with a pediatrician may be necessary to monitor for the systemic adverse effects if prednisone is used or if there is suspicion of systemic involvement.